Patients with acute coronary syndromes who received a low dose of the oral anticoagulant rivaroxaban, when substituted for aspirin in dual antiplatelet therapy (DAPT), had a similar risk of clinically significant bleeding as patients receiving standard DAPT in a phase 2 trial published in The Lancet. Nearly 10% of patients treated with standard DAPT therapy—aspirin combined with P2Y12 inhibitors clopidogrel or ticagrelor—still experience major cardiovascular events. Research is addressing the possibility of adding antithrombotic agents such as rivaroxaban to aspirin and clopidogrel to reduce cardiovascular adverse events in such patients. However, previous studies have suggested that the addition of antithrombotic agents to DAPT causes an excessive risk of bleeding.
Slomski A. Redefining Acute Coronary Syndrome Therapy. JAMA. 2017;317(20):2054. doi:10.1001/jama.2017.6081
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